Pulling reflexology out of one’s nether regions

Remember how I speculated that perhaps Age of Autism or NaturalNews.com would provide me with the first topic of my next year of blogging? It turns out that I was wrong. It didn’t come from either of those sources, although I will reassure the antivaccine loons at AoA and Mike Adams at NaturalNews.com not to fear. I’ll get to them soon enough. The Huffington Post, too, given that apparently Mark Hyman’s back with his woo. In any case, AoA and Mike Adams may at times be utterly hilarious, but they can’t compare to what readers pointed out to me over the weekend and PZ blogged about. It was almost enough to entice me to write about it a day early. Almost, but not quite. I’m going to try to be mellower about the the manic blogging, and, besides, my “friend” was even more logorrheic than usual at the other blog, if you know what I mean, which is part of the reason I decided to defer going after Mark Hyman’s woo for at least a day. It would have required more verbiage and research than I have the energy left to do, and, besides, last week was just way, way too depressing. Dealing with a woman dying of breast cancer unnecessarily because she chose quackery over effective science-based medicine.

On the lighter side, if there’s one thing about so-called “complementary and alternative medicine” (CAM) modalities, it’s that nothing–and I do mean nothing–is too ridiculous not to be accepted almost instantly by CAM aficianados. Think about the modalities that are already out there. Homeopathy, for instance, expects its adherents to believe not only that, to cure a symptom you need to make a remedy from something that causes the symptom, but that diluting said remedy actually makes it stronger, with the very strongest remedies having been diluted far beyond Avagadro’s number, meaning that they are incredibly unlikely to have even a single molecule of the original substance in it. But, hey, if you believe that water has memory, it’s all good. Then there’s reiki. To believe in reiki, you have to believe that it is possible for a “healer” to channel mystical energy from a “universal source” into a person to achieve healing. Yes, reikie is nothing more than faith healing that substitutes Eastern mysticism for Christian beliefs as the basis for its magical healing. Then there’s acupuncture. To believe in acupuncture, it’s necessary to believe that a person’s life force energy (or qi) flows down various channels (or “meridians”) in the body. This energy cannot be detected, nor do these meridians correspond to any anatomical structures that can be detected. However, supposedly inserting little needles into these meridians can “unblock” the flow of qi and thereby heal.

I could go on, but let me ask you something. If someone postulated that every part of your body mapped to somewhere on your–if you’ll excuse me–ass, what would you say? Would you think anyone would believe it? Think no more! (Certainly the people evaluating this claim didn’t.) John C McLachlan, a professor of medical education at Durham University basically, well, pulled something out of his ass if you will, and showed skeptics the way with a hilarious Sokal-type hoax, an account of which he published in BMJ last week in an article entitled Integrative medicine and the point of credulity. He starts it out with two brilliant sentences:

So called integrative medicine should not be used as a way of smuggling alternative practices into rational medicine by way of lowered standards of critical thinking. Failure to detect an obvious hoax is not an encouraging sign.

It is sometimes possible to test the status of a notion (the terms hypothesis and theory should be reserved for ideas that are related to at least some form of evidence) by a process of opposition. This involves testing the status of the notion by looking at the limits to which it can be pushed.5 Furthermore, there is an excellent tradition of testing research areas of dubious authenticity by means of a hoax. In 1996, Alan Sokal had a paper accepted in a cultural studies journal, in which he parodied postmodern philosophy and cultural studies by making a series of exaggerated, wrong, and meaningless statements about the potential progressive or liberatory epistemology of quantum physics in the style of the field. This he subsequently described in a book, bluntly called Intellectual Impostures. In the spirit of Sokal, therefore, I responded to a mass circulated email invitation to submit a paper to something called “The Jerusalem Conference on Integrative Medicine.”

McLachlan’s response to the call for abstracts was brilliant:

I write to ask if you would be interested in a presentation on my recent work on integrative medicine. I am an embryologist by background, with an extensive publication record, in journals including Nature and the Proceedings of the Royal Society, and have written an award winning text book on medical embryology. Recently, as a result of my developmental studies on human embryos, I have discovered a new version of reflexology, which identifies a homunculus represented in the human body, over the area of the buttocks. The homunculus is inverted, such that the head is represented in the inferior position, the left buttock corresponds to the right hand side of the body, and the lateral aspect is represented medially. As with reflexology, the “map” responds to needling, as in acupuncture, and to gentle suction, such as cupping. In my studies, responses are stronger and of more therapeutic value than those of auricular or conventional reflexology. In some cases, the map can be used for diagnostic purposes.

I have to hand it to McLachlan. In fact, I’m envious. I wish I’d thought of it first. But I didn’t; so I have to settle for my current level of amusement. The fact that he refrained from making an analogy to phrenology just adds to the brilliance. Making that analogy might have been going just a bit too far. On the other hand, perhaps pushing the hoax a little farther would have been worth it. Surprisingly, he got a positive response, which led to his submitting this abstract:

Intensive study of the development of early human embryos indicates that there is a reflexology style homunculus represented in the human body, over the area of the buttocks. This homunculus corresponds to areas of clonal expansion (“Blaschko lines*”), in which compartments of the body have clear ontological relationships with corresponding areas of the posterior flanks. The homunculus is inverted, such that the head is represented in the inferior position, the left buttock corresponds to the right hand side of the body, and the lateral aspect is represented medially. The Blaschko lines mediate energy flows to parent areas, and lead to significant responses to appropriate stimuli. As with reflexology, the “map” responds to needling, as in acupuncture, and to gentle suction, such as cupping. Responses are stronger and of more therapeutic value than those of auricular or conventional reflexology. In some cases, the map can be used for diagnostic purposes. In both therapeutic and diagnostic interventions, a full case history must be taken, in order to define the best methods of treatment. In the presentation, anonymised case histories, “testimonies” and positive outcomes will be presented. The methodology does not lend itself to randomised double blind controlled trials, for obvious reasons.

Obviously, the involvement of a sensitive area of the body poses special challenges. Ethical practice is of significant concern. Informed consent must be obtained from all patients in writing, before either therapeutic or diagnostic procedures are commenced. Although exposure of the gluteal region is recommended, procedures can be carried out using draping if this is required in order to gain patient cooperation. Chaperones or same sex practitioners are recommended in the case of female patients.

Unfortunately, this novel paradigm may meet with closed minds and automatic rejection. Patience and understanding of “closed” mindsets is essential in order to advance this new discovery in a way commensurate with its importance.

Guess what? McLachlan’s abstract was accepted! But it wasn’t just accepted for a poster. Oh, no. It was accepted for a full talk, 15 minutes!

Now here’s where McLachlan disappointed me. Here I was, becoming more and more admiring by the minute as I read, thinking that McLachlan to be an utter genius, and then he had to go and ruin the effect. How? He chickened out. Instead of actually accepting the invitation to go and to give his talk, he (if you will excuse the term) backed out of his talk. Damn attack of conscience!

Still, it’s not surprising that the “scientific committee” of the conference accepted the idea of butt reflexology. I mean, given how inherently ridiculous reflexology is, why not butt reflexology? After all, look at the map of foot reflexology:

Hand reflexology:

And ear reflexology:

Then, of course, there’s also the seeming obsession with the colon that underlies so much alternative medicine. There’s hydrotherapy, enema therapy, coffee enemas, not to mention all manner of purgatives. The bottom line–if you’ll excuse the word, given the emphasis on butt reflexology–is that there is nothing too ridiculous that it won’t take in someone in the alternative medicine world. If you don’t believe me, just take a look at what the schedule for the Jerusalem Conference on Integrative Medicine finally ended up looking like. Perhaps my favorite title from the list is Dr. Chaim Rosental’s talk, A combined homeopathic-Kabbalistic approach to integrate the meaning of mind and body manifestations.

Hmmmm. Homeopathy and Kabbalah. Two woos that woo great together. I wonder what homepathic Kabbalah would look like. It makes my brain hurt to think about it, which sort of reinforces my point. Nothing, and I mean nothing, is too inherently ridiculous for alternative medicine to reject.

Though thinking on it – what happens when those nasty materialistic medical doctors like Orac tear them a new one? Do they get twice the benefit as diluting arse kissing over two arses should increase the effect?

I don’t particularly blame him for not following through with the conference. It’s a dangerous place to be for a rational person. Grossly outnumbered. Why, the heat from all the burning stupid might incinerate him in seconds!

On another note, I got that e-invite, too. Would that I’d thought of something like that.

This will provide economic incentive to start seriously scrubbing the atmosphere, as well as for various industries and energy companies to install scrubbers on their smokestacks. I thought it would be carbon-fiber materials that would do the trick, but apparently the stuff that comes out of smokestacks is difficult and costly to turn into usable carbon-fiber mesh.

I’ve been meaning to write up a pseudo-paper on retrophrenology. Since phrenology is all about studying bumps on the head to understand human behavior, retrophrenology would be about beating a head into a certain shape in order to elicit a certain behavior. My mother used it. My grandmothers used it. And, now my wife is using it. And they’re all great at it. I do stuff because I get beat on the head, not because my head is of a certain shape. What do you all think?

As I wrote on PZ’s blog, the impact of this hoax is diminished somewhat by the fact that he claimed to have case studies, which of course would have been fabricated had he gone through with it. I can see a legitimate conference giving somebody a 15 minute talk to discuss some promising case studies regarding a methodology that, in the context of the state of the art of that field, was novel but not implausible (again, in the context of the state of that field).

It is less an indictment of the critical thinking skills of the conference organizers — both quack science and legitimate science are forced to assume good faith in regards to authors’ claims of evidence, and it’s not at all unheard for legitimate journals to publish “further research is needed” papers based solely on case studies. But it is funny that the context of alternative medicine is so loony that something like this would be deemed prima facie plausible 🙂

@ Raging Bee : No,no,no! It most definitely is *not* a hoax: it’s a *modern version* – what you refer to as the Rolling Stones logo *actually* is that! This lower ear region is stimulated to assist patients who are dealing with serious addicitions** ( it’s colloquially called the “Richards point”). And what you refer to as the ” business end of the penis” represents the “fact” that Kundalindi energy flows via the spine** to (yes) the penis.

I’ve seen ads for colonic reflexology- it was touted as one of the benefits of colonic irrigation. It was just a little aside in the irrigation pamphlet, about how colonic irrigation can help you with any disease because there’s a body map on the colon as well as the foot.

My thoughts were similar to jay.sweet’s thoughts on the subject. If a respected well-published expert in a field claimed to have evidence of something that to me, a complete non-expert, seemed silly, I’d want to hear his/her evidence before deciding if it was silly.

It isn’t really a Sokal-like hoax in which he used their own post-modernist jargon and strung it together in different ways. McLachlan did use some of their terms, but the sentences actually make sense (unlike Sokal’s), and he also claimed to have evidence.

And the cynical narrative voice in the Pratchett, after noting that you could order artistic temperament but what you actually got was being hit on the head, observes that at least it stimulates the economy.

@ Mu, Vicky: Let’s hear it for Pratchett! BTW, the SubGenius themselves may well have been inspired by the Discworld here, since “retrophrenology” was first introduced in the 1993 novel Men At Arms, well before 1997, then.http://wiki.lspace.org/wiki/Retrophrenology

“…the impact of this hoax is diminished somewhat by the fact that he claimed to have case studies…”

I’m not sure this diminishes the impact of the hoax, since even homeopaths claim to have case studies, and their “treatment” is indistinguishable from placebo. For that matter, I’m not sure that a lack of case studies would have resulted in Dr. McLachlan’s abstract being rejected, given the quality of the other presentations (e.g. “The Healing Pyramid”).

Jay Sweet goes on to say:

“I can see a legitimate conference giving somebody a 15 minute talk to discuss some promising case studies regarding a methodology that, in the context of the state of the art of that field, was novel but not implausible…” [emphasis added]

In the context of “Integrative Medicine”, buttock reflexology may not seem “novel but not implausible”, but that is exactly the point. Once you open your mind wide enough to find reflexology or homeopathy “not implausible”, then you have no defense against any nonsense that might wander in. I think that is exactly the point of Dr. McLachlan’s hoax.

There may be effective therapies that are currently considered “CAM” – “CAM” consists of those treatments that haven’t been shown to work, a set which includes not only treatments that haven’t been adequately studied but also treatments that have been adequately studied and shown to be ineffective.

One of the (myriad) problems with “CAM” is that it cannot discriminate between plausible and implausible hypotheses. “CAM” practitioners and supporters seem exceedingly reluctant to criticise each other’s practices, even when those practices are patently absurd (e.g. homeopathy, chiropractic, reflexology, iridology, etc., etc….). The result is that the “CAM” tent fills up with ridiculous “therapies” that have no real hope of working. Further contributing to the worthlessness of “CAM” is the fact that any “CAM” treatment that is found to actually be effective is immediately transferred to real medicine.

So, bravo for Dr. McLachlan for showing – yet again – that the “CAM”/”Integrative Medicine” emperor has no clothes.

He chickened out. Instead of actually accepting the invitation to go and to give his talk.

He shouldn’t have “chickened out” — he should have given the talk and “chickened” it. Redo Doug Zongker’s infamous “Chicken Chicken Chicken: Chicken Chicken” as “Spirit Spirit Spirit: Spirit Spirit” and see if anyone in the audience catches on or objects. After all, he’d be ever so holistic by bringing the much-neglected spiritual component into medicine — and that usually rates automatic approval and pass with the alties.

Years ago I came across an account of iridology that explained the appeal of the iris-to-body mapping: basically the irides are the two muscles in the human body that are circular (i.e. mandala-form) and directly accessible for observation.

Needless to say, the anal sphincter also meets these criteria. But sadly I never got around to writing a book-length description of Anusology.

Then, of course, there’s also the seeming obsession with the colon that underlies so much alternative medicine. There’s hydrotherapy, enema therapy, coffee enemas, not to mention all manner of purgatives.

I once asked a quackster selling ear candles at our local Farmers’ Market what would happen if one was to use them in ‘another’ oriface.

By rights with their incredible suction power the answer should be faeces – shouldn’t it? Of course what you’d really get is ‘earwax’ – the same stuff ear candles allegedly draw out of ears, (while magically stopping short of extracting your brain at the same time, of course)

Oh, and needless to say, he replied that he had no interest in speaking with somebody whose mind was so obviously closed as mine. I wonder why!

I do believe many of you have shamefully overlooked the obvious therapeutic benefits of this therapy as well as the ease and simplicity of case studies. To wit I asked three of my mates “How does your spouse feel after you tickle his/her/its/their butt?” The responses were (1) “they felt better”, (2) “he felt pretty good”, and (3) an answer that strayed into “too much detail” territory. Though with the latter I was reasonably confident that it could be interpreted as “she felt much better”. Obviously for clinical trials rigid definitions should be used to avoid ambiguity. For example, what do the words “better”, “felt”, “more” and “good” actually mean?

@Prometheus: Yeah, I pretty much agree with you, and that’s why I said in my final sentence that the main problem was that “that the context of alternative medicine is so loony that something like this would be deemed prima facie plausible.” That said, I stand by my point that the impact of the hoax is diminished by the false claim of case studies, especially in light of your comment here:

I’m not sure that a lack of case studies would have resulted in Dr. McLachlan’s abstract being rejected, given the quality of the other presentations

Indeed, that’s the whole point. If he hadn’t (fraudulently, it might be argued!) claimed to have documented case studies, then we could point and laugh at not only the absurd “context” that would make ass reflexology a plausible modality, but we could also point and laugh at their complete failure to require even the most scant forms of “evidence”.

(As you point out, homeopaths have case studies, so that means very little… but presumably they are actual real documented case studies, which is a legitimate way to generate hypotheses. When your hypothesis is clearly implausible, or if it has already been thoroughly disproven by experiment (or both, in the case of homeopathy) then of course case studies matter not. But accepting a paper based solely on case studies is not in and of itself a problem)

You said it right here:

One of the (myriad) problems with “CAM” is that it cannot discriminate between plausible and implausible hypotheses.

Indeed, and McLachlan’s hilarious hoax demonstrated that clearly. But if he’d left out the bit about case studies, it very well might have demonstrated yet another of “the (myriad) problems with ‘CAM'” — that the community lets people just make shit up, and then present it as fact without even going to the bother of having anecdotal “evidence” in hand.

Moreover, I didn’t mention it in my initial post, but it’s somewhat troubling that if this hoax had been perpetrated on a legitimate journal and McLachlan had gone through with it, we’d call that “fraud”, which is pretty much the most grievous sin a researcher can commit (arguably, murdering your lab assistants is slightly worse… unless they are just interns, I suppose). Again, I don’t mean to be a wet blanket… but there would have been significantly more Awesomeness if he’d pulled off the hoax while also playing 100% by their rules.

“…if he’d left out the bit about case studies, it very well might have demonstrated yet another of “the (myriad) problems with ‘CAM'” — that the community lets people just make shit up, and then present it as fact without even going to the bother of having anecdotal “evidence” in hand.”

True. That was a missed opportunity. But it did inspire me to respond the next time I get one of those e-mail “requests for abstracts”. I’ll see if I can get a “theoretical” paper accepted. If so, I’ll post it to my ‘blog.

” it’s somewhat troubling that if this hoax had been perpetrated on a legitimate journal and McLachlan had gone through with it, we’d call that “fraud”, which is pretty much the most grievous sin a researcher can commit (arguably, murdering your lab assistants is slightly worse… unless they are just interns, I suppose).”

Good point. However, accusing McLachlan of fraud for submitting a made-up abstract to this conference would be like giving out speeding tickets at Le Mans.

Also, while murdering lab assistants is a felony (in most jurisdictions), I don’t think that it would automatically cause you to lose tenure. Fradulent publication is grounds to revoke tenure.

Hi, I’m the author of the piece in question. Prometheus (” Once you open your mind wide enough to find reflexology or homeopathy “not implausible”, then you have no defence against any nonsense that might wander in”) accurately describes my position. The idea that your posterior maps meaningfully to body organs would be, I believed, risible to believers in rational medicine, but seem perfectly sensible to believers in what I call âAlternative Universe Medicineâ (acronym pronounced âOmâ, of course). Itâs a bit as if I had submitted an abstract describing use of laboratory unicorns. I wished to see if this hoax was a distinguishing test. Many of the responses (here and on Pharyngula) suggest that it is indeed intrinsically risible. I would side with Kimball Atwood at Science Based Medicine in believing that it is important to consider the prior probability of an event, as well as the simple stats of outcomes.

I do take Jay Sweetâs point, but personally would distinguish between âfraudâ and âcomic hoaxâ over intentionality. It is always the purpose of a comic hoax to reveal the true situation in time. Fraud requires the intention to remain secret. And I chose case histories as the lowest grade of evidence, and the one most liable to delusion, since it is the industry standard in AUM.

As the article may hint, I did think seriously about the ethics aspects, and I had helpful discussions with colleagues, friends, and BMJ editorial staff. But part of my motivation was to create a âtrue anecdoteâ as an antidote to the simplified and false anecdotes used in AUM, increasingly disguised in integrative medicine clothing, and I hope I have done this.

And of course, I had no idea that Poe’s Law would turn out to apply here quite so appositely!

@32 wrote @28 – fecal transplants (definitely not DIY) have been used with some success for C Dificile infections.

True, I first learned about it from a cattle farmer neighbour of mine after the first 2 rounds of antibiotics failed to curb my wifes C. dif. infection. Luckily, the third round of antibiotics got it under control and we didn’t have to resort to Buck’s treatment. But after watching a healthy young woman fade away as she shed her intestines, I can understand why desperate people try desperate things.

“To believe in acupuncture, it’s necessary to believe that a person’s life force energy (or qi) flows down various channels (or “meridians”) in the body.”

I disagree. You can believe that acupuncture provides relief while admitting that the mechanism is unknown. Some folks believe the reported relief is from a surge of endorphins following the needling, I don’t know. But you can believe in the phenomenon without buying someone’s explanation for the mechanism underlying the phenomenon.

Reminds me of the old saying, “even a broken clock is right twice a day”

The trouble with your response is that the very term “believe in acupuncture” is ill-defined. The rest of the quoted sentence is just a definition of how acupuncture supporters say they think it works.

Do I believe that there are a lot of people performing something they call “acupuncture”? Certainly!

Do I believe that poking, prodding, or sticking needles into my skin might provide temporary relief from other pain? Maybe. I used to brush my teeth to provide temporary relief from a toothache. The effect didn’t last, but it helped cope until I could get to see a dentist and really fix the problem.

Do I believe that there are specific places where you should stick the needles to treat different conditions and that it makes a difference where you stick the needles? No! I’m from Kansas and that’s close enough to Missouri to say, “show me the evidence”.

So far the body of evidence shows that it doesn’t matter where you stick the needles or if they even penetrate the skin. So saying there is evidence that shows acupuncture works is misleading at best and provides unwarranted support for claims about meridians and qi at worst.

You don’t need to understand the mechanism for a treatment or mechanism to demonstrate that it works. But you need to at least demonstrate that it works.

I am currently taking Levitiracetam (Keppra) to control occasional seizure episodes. It’s about the 5th or 6th medicine I have taken for this condition and seems to work the best. i.e., I haven’t had any episodes for a year. But the Wikipedia article states:

The exact mechanism by which levetiracetam acts to treat epilepsy is unknown. However, the drug binds to a synaptic vesicle protein, SV2A,[4] which is believed to impede nerve conduction across synapses.

Or, as PubMed Health put it,

It works by decreasing abnormal excitement in the brain.

As if that explains how. But, at least I have objective evidence (based on observations by another party) that it works well for me.

“The trouble with your response is that the very term “believe in acupuncture” is ill-defined.”

True, which is why I said, “believe that acupuncture provides relief “. The ‘ill-defined’ term ‘believe in acupuncture’ came from Dr. Orac.

“at least I have objective evidence (based on observations by another party) that it works well for me.

I can’t say that for acupuncture.”

Well, I can say that I have objective evidence (based on observations by another party) that acupuncture worked well for me.

Did the needles have to be in a certain spot along my “energy” lines or whatever, I don’t think so. Did the needles even have to penetrate the skin, perhaps not. There is a lot of evidence that mere physical contact (grooming in non-human primates) changes hormone levels and reduces stress.

In my case acupuncture provided relief from severe pain that did not respond to pharmacological intervention. I have a Ph.D. in biochemistry and I am very sceptical and a vocal critic of alternative treatments. But I went for the treatment out of desperation and trust me, I was shocked by the relief I experienced. I don’t know why it worked for me, placebo perhaps, but I doubt it.

The fact that it does not matter where the needles are stuck or even whether they penetrate the skin at all strongly suggests that any benefits derived from acupuncture are due to placebo effects (which are real phenomena, but are due to the non-specific effects of treatment, rather than the treatment itself). It is interesting that treatments such as acupuncture only seem to work on subjective symptoms, like pain, but fail on objective measures.

I’m not sticking up for either party here, but i have to say that this debate sounds dogmatic and immature. With the exception of Billnut, you should all really try to consider the fact that our current science doesnt necessarily have all the answers and that in the future a lot of the things you are criticising may turn out to be more than quackery. Again, i’m not advocating any of these treaments, but might it be wise to be slightly less arrogant?

it would appear that ’tis the season for false accusations of “dogma” from woo sympathizers against skeptics, coupled with vague and fuzzy appeals to ignorance (“there are things we don’t know,” therefore woo works, or at least we have to take it seriously).